Learning Objectives. Is FSH testing helpful in diagnosing perimenopause? Issues for the peri menopausal woman. Presenter Disclosure Information

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Learning Objectives. Is FSH testing helpful in diagnosing perimenopause? Issues for the peri menopausal woman. Presenter Disclosure Information"

Transcription

1 5 5:45 pm Managing Menopause: Before, During and After Presenter Disclosure Information The following relationships exist related to this presentation: Jane S. Sillman, MD: No financial relationships to disclose. SPEAKER Jane S. Sillman, MD Off-Label/Investigational Discussion In accordance with pmicme policy, faculty have been asked to disclose discussion of unlabeled or unapproved use(s) of drugs or devices during the course of their presentations. Learning Objectives Managing Menopause: Before, During and After Jane S. Sillman, MD Assistant Professor of Medicine Harvard Medical School 1. Apply strategies to help manage patients with their symptoms through peri and postmenopause 2. Outline mechanisms to help patients better handle the physical and emotional changes of this period 3. Discuss the latest data on hormone therapy and its pros and cons Issues for the peri menopausal woman Hot flashes Irregular bleeding MORE (more frequent, more days of bleeding per cycle, heavier bleeding) MUST be evaluated: pregnancy test, pelvic USG, endometrial biopsy LESS (less frequent, fewer days, lighter) doesn t need additional evaluation in woman older than 45 Still needs contraception Is FSH testing helpful in diagnosing perimenopause? Serum FSH levels are very variable NOT required to make diagnosis If normal, may be misleading If amenorrhea of >60 days and no other symptoms, FSH > 25 can be reassuring that amenorrhea is due to perimenopause and nothing else

2 Best treatment Low dose oral contraceptive (OC) pill: will control the bleeding will treat the hot flashes will provide contraception Use pill with mcg of ethinyl estradiol Contraindications to low dose OC use in perimenopause Obesity: greater risk for thromboembolic complications Smoking Hypertension Migraines Other contraindications to systemic estrogen N Engl J Med 2008; 358:1262 How long to continue the estrogencontaining pill Stop by age Taper by 1 active pill a week Patient should then use condoms for 12 months If no menstrual bleeding for 12 months after stopping the pill: she is officially in menopause and contraception is no longer needed can then assess re whether treatment is needed for menopause symptoms Contraindications to hormone therapy (HT) Breast cancer Coronary heart disease (CHD) Hx of venous thromboembolic event (VTE) Hx of stroke Active liver disease High risk for these complications J Clin Endocrinol Metab 2015;100:3975 Calculating 10 year risk for atherosclerotic cardiovascular disease (ASCVD) Use the new American College of Cardiology (ACC) American Heart Association (AHA) online calculator: google: ACC cardiac risk ACC AHA assessments of risk: < 7.5% ten year risk: low >7.5% ten year risk: moderate to high Efficacy of hormone therapy (HT) Estrogen is the most effective treatment for relief of menopausal symptoms combine with a progestin in women with a uterus alone in women with hysterectomy Cochrane Database Syst Rev 2004; :CD002978

3 Current estimates of risks of hormone therapy (HT) in women ages Stuenkel CA, et al. Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2015 Combined estrogen progestin therapy: number of cases per 1000 women per 5 years of hormone use compared to placebo Coronary heart disease (CHD): 2.5 additional cases Invasive breast cancer: 3 additional cases Stroke: 2.5 additional cases Pulmonary embolism: 3 additional cases Colorectal cancer: 0.5 fewer cases Endometrial cancer: no difference Hip fracture: 1.5 fewer cases All cause mortality: 5 fewer events Stuenkel CA et al. J Clin Endocrinol Metab 2015 Estrogen alone therapy: number of cases per 1000 women per five years of hormone use compared with placebo CHD: 5.5 fewer cases Invasive breast cancer: 2.5 fewer cases Stroke: 0.5 fewer cases Pulmonary embolism: 1.5 additional cases Colorectal cancer: 0.5 fewer cases Hip fracture: 1.5 additional cases All cause mortality: 5.5 fewer events Stuenkel CA et al. J Clin Endocrinol Metab 2015 Current conclusions about risk of hormone therapy (HT) Risks in younger postmenopausal women (ages 50 59) are significantly lower than in women in their 60s (the women studied in the WHI) Due to lower baseline risk of CHD, stroke, VTE and breast cancer in younger women Combined estrogen progestin therapy is associated with higher risk of CHD and breast cancer than unopposed estrogen JAMA 2013; 310:1353 Helpful tool: MenoPro App Evidence based free mobile app created by the North American Menopause Society to guide women through decision making about therapies for menopause symptoms Downloadable to mobile iphone/ipad Designed for women > 45 years old with systemic and/or vaginal symptoms MenoPro: how it works Asks questions Are you in menopause? How severe are your symptoms? What is your CV risk, and calculates it Increased risk for breast or endometrial cancer? Presents evidence based info about risks, benefits of each treatment option Recommends lifestyle modification for >3 months Menopause 2015;22(3):254

4 MenoPro recommendations based on 10 year CV risk Low (< 5%) and less then 10 yrs since menopause: candidate for either oral or transdermal therapy Moderate (5 10%) and less than 10 yrs since menopause: transdermal estrogen may be best option: less adverse effects on clotting factors, triglycerides, inflammation factors High (>10%): avoid systemic hormone therapy Using the MenoPro app Provides personalized decision making Takes only 2 3 minutes App provides summary that can be printed out or ed to patient Try it! Menopause 2015;22(3):254 Options for our patient Decide about type of estrogen, the route, the need for progestin, most appropriate progestin regimen Oral estrogens: Side effects Increase serum triglycerides Increase risk of venous thromboembolism (VTE) and stroke more than transdermal estrogen Risk is very low in healthy, young postmenopausal women so oral estrogen can be used if patient prefers it My recommendation: Transdermal 17 beta estradiol Transdermal: advantages over oral Does not increase triglycerides Less risk of venous thromboembolism and stroke 17 beta estradiol: main estrogen the ovary produces prior to menopause Estrogen dose Start low, titrate up if necessary Start with transdermal estradiol mg patch, or oral estradiol 0.5 mg/day If hot flashes not relieved after 1 month, increase transdermal to mg, oral to 0.75 mg, reassess after 1 month If symptoms persist, increase to 0.05 mg transdermal, 1 mg oral Am J Med 2005; 118 Suppl 12B:74

5 Adding a progestin All women with intact uterus need a progestin in addition to estrogen to prevent endometrial hyperplasia Women who have had hysterectomy do not need a progestin Options: medroxyprogesterone acetate The progestin used in the Women s Health Initiative (WHI) Was associated with increased risk of coronary heart disease, breast cancer when given with conjugated estrogen in the WHI Micronized progesterone Thought to be safer for the heart: no adverse lipid effects Possibly safer for the breast These benefits not yet proven My recommendation: micronized progesterone For newly menopausal woman: Estrogen daily Cyclic progestin 200 mg on days 1 14 of month Decreases likelihood of irregular, unscheduled bleeding >2 3 years post menopause: continuous dose Less risk of irregular bleeding Estrogen daily plus progestin 100 mg daily Progestin side effects Mood symptoms Bloating Worse with cyclic dosing What to do: switch to continuous Women who can t tolerate any oral progestin Off label use of new lower dose levonorgestrel IUD Contains 13.5 mg levonorgestrel Releases mg/day, with gradual decrease to mg/day after 3 years In contrast, standard levonorgestrel IUD: 52 mg No data on long term safety in postmenopausal women

6 NEW: Conjugated estrogen/bazedoxifene New class of drugs: tissue selective estrogen complex (TSEC) Combination of conjugated estrogen (CE) and selective estrogen receptor modulator (SERM) Approved for treatment of postmenopausal hot flashes and osteoporosis prevention Conjugated estrogen (CE)/Bazedoxifene (BZA) Estrogen agonist effects on bone, antagonist effects on endometrium, neutral effects on breast Dose: CE 0.45mg/BZA 20 mg daily Decreases hot flashes by 75% (vs. 50% for placebo) Increased risk of venous thromboembolism with BZA. No data on? additive risk with CE Obstet Gynecol 2013;121:959 Menopause 2009; 16:1116. J Bone Miner Res 2008; 23:1923 When to stop hormone therapy After 5 years or less of use Observational studies: 65 75% of women stop within 2 years J Clin Endocrinol Metab 2008; 93:4567 Am J Med 2005;118 Suppl 12B:163 Continuing hormone therapy (HT) after age 65 North American Menopause Society (NMAS): New position statement Continuing HT past age 65 is acceptable IF The woman has been advised of increased risks after age 60 She continues to have bothersome symptoms Unable to use any other appropriate medication Her clinician has determined that benefits outweigh risks Menopause 2015 Jul; 22:693 How to stop No data that tapering is more effective than stopping abruptly WHI: 55% will have recurrent hot flashes if hormone therapy stopped abruptly Discuss options of taper vs. stop with patient My recommendation: just stop What if symptoms recur? Try non estrogen alternative: SSRI or gabapentin If ineffective, restart estrogen at lowest dose if benefits outweigh risks JAMA 2005;294:183 J Clin Endocrinol Metab 2010;95:257

7 Non hormonal therapy: SSRIs and SNRIs Venlafaxine, desvenlafaxine, paroxetine, citalopram, escitalopram appear to have similar benefit No head to head trials available Efficacy demonstrated in multiple trials Clinical response is more rapid (days) than response for depression (weeks) Sertraline, fluoxetine: not effective JAMA 2006; 295:2057. Obstet Gynecol 2007; 109:823 My recommendation: Venlafaxine sustained release 37.5 mg/day for 1 week, increasing to 75 mg/day after 1 st week Side effects: nausea, decreased with use of sustained release and gradual dose increase Preferred in women taking tamoxifen: minimally blocks conversion of tamoxifen to active metabolites JAMA Intern Med 2014; 174: 1058 Low dose paroxetine (7.5 mg/day) Only agent approved by FDA for treatment of hot flashes Expensive, not covered by many insurers Can use 10 or 20 mg/day and 12.5 or 25 mg/day controlled release doses (off label) Avoid in women taking tamoxifen: blocks conversion of tamoxifen to its active metabolites Citalopram or escitalopram Off label use Optimal dose: 20 mg Side effects minimal Menopause 2013; 20:1027 J Clin Oncol 2010; 28:3278. JAMA 2011; 305:267 Anticonvulsant: Gabapentin May be better option for women whose hot flashes are mainly at night Start with 100 mg one hour before bedtime, increase by 100 mg every 3 nights until relief of hot flashes, side effects or maximum of 900 mg Higher doses, up to 2400: more efficacy but more side effects: headache, dizzy Symptoms of vaginal atrophy Dryness, burning, pain on intercourse Urinary symptoms: urinary frequency, frequent bladder infections Lancet 2005; 366:818

8 First line treatment: vaginal moisturizers and lubricants Helpful for mild symptoms Use of moisturizer several times a week Use of lubricant before sexual activity All are OTC Vaginal estrogen For moderate severe symptoms Low dose recommended More effective than systemic therapy Minimizes systemic estrogen effects Creams, tablets, rings: similarly effective Obstet Gynecol 1998; 92(4 Pt 2):722 Low dose Preparations Tablet: 10 mcg estradiol, insert in vagina nightly x 2 weeks, then twice a week Vaginal ring: Releases 7.5 mcg estradiol daily into vagina for 90 days Cream: Conjugated estrogen: 0.3 mg CE/0.5 g cream Estradiol: 50 mcg estradiol/0.5 g cream Daily x 2 weeks, then twice a week Serum estradiol levels Average level for postmenopausal woman: 5 pg/ml 10 mcg estradiol tablet: 3 11 pg/ml Ring: 5 10 pg/ml Creams: Conjugated estrogens: made up of many compounds. Serum estradiol level doesn t reflect total absorption Estradiol: 50 mcg/0.5 g: no data Climacteric 2010; 13(3):219 Use of progestin Not needed with the tablet or ring Vaginal creams: use progestin days a month e.g. micronized progesterone 200 mg days 1 12 each month How long to continue low dose vaginal estrogen Can be continued indefinitely due to low risk of adverse effects Safety data available only up to 1 year Menopause 2010; 17(2):242

9 NEW: Ospemifene Selective estrogen receptor modulator (SERM) Estrogen agonist in vagina No estrogen effect on breast or endometrium One 60 mg pill daily Good for women who can t or don t want to use a vaginal product Side effects Hot flashes Potential for thromboembolic events: no data yet Take home points 1. Peri menopausal women may need treatment for hot flashes, irregular bleeding and contraception. A low dose combined oral contraceptive pill is an effective choice. 2. MORE bleeding in peri menopause (more frequent, more days/period, heavier bleeding) needs full evaluation 3. Many menopausal women who need treatment for hot flashes can be safely treated with hormonal therapy for up to 5 years 4. Non hormonal therapy can effectively treat menopausal symptoms for years Menopause 2010 May; 17(3): 480 Take home points, continued 5. Symptomatic vaginal atrophy can be treated for years with low dose local estrogen or ospemifene 6. Try the MenoPro app: a useful tool for helping your patient with her menopause symptoms

WHOLE HEALTH: CHANGE THE CONVERSATION. Hormone Replacement Therapy Clinical Tool

WHOLE HEALTH: CHANGE THE CONVERSATION. Hormone Replacement Therapy Clinical Tool Advancing Skills in the Delivery of Personalized, Proactive, Patient-Driven Care Hormone Replacement Therapy Clinical Tool This document has been written for clinicians. The content was developed by the

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Hormone Therapy

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Hormone Therapy Hormone Therapy WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 At menopause, a woman's body makes less estrogen and she stops having menstrual periods. This is a natural stage in a woman's

More information

A Practitioner s Toolkit for the Management of the Menopause

A Practitioner s Toolkit for the Management of the Menopause Medicine, Nursing and Health Sciences A Practitioner s Toolkit for the Management of the Menopause Developed by the Women s Health Research Program School of Public Health and Preventive Medicine Monash

More information

patient education Fact Sheet PFS003: Hormone Therapy APRIL 2015

patient education Fact Sheet PFS003: Hormone Therapy APRIL 2015 patient education Fact Sheet PFS003: Hormone Therapy APRIL 2015 Hormone Therapy Menopause is the time in a woman s life when she naturally stops having menstrual periods. Menopause marks the end of the

More information

New combination in the market

New combination in the market New combination in the market Z.Shahverdi M.D GynOncologist 17/02/2016 HRT was first available in the 1940s but became more widely used in the 1960s, creating a revolution in the management of the menopause

More information

The menopausal transition usually has three parts:

The menopausal transition usually has three parts: The menopausal transition usually has three parts: Perimenopause begins several years before a woman s last menstrual period, when the ovaries gradually produce less estrogen. In the last 1-2 years of

More information

(212) 733-2324 mackay.jimeson@pfizer.com

(212) 733-2324 mackay.jimeson@pfizer.com For immediate release: July 9, 2012 Media Contacts: MacKay Jimeson (212) 733-2324 mackay.jimeson@pfizer.com Pfizer Recognizes 10 th Anniversary Of The Women s Health Initiative: A Modern Day Perspective

More information

Menopause Management Update 2016

Menopause Management Update 2016 Disclosure statement Menopause Management Update 2016 Dr Elizabeth Farrell AM Hon LLD FRANZCOG FRCOG Head Menopause Unit, Monash Health Acting Medical Director, Jean Hailes Medical Centre Expert panel

More information

Menopause Guidance on management and prescribing HRT for GPs based on NICE guidance 2015

Menopause Guidance on management and prescribing HRT for GPs based on NICE guidance 2015 PRIMARY CARE WOMEN S HEALTH FORUM GUIDELINES Menopause Guidance on management and prescribing HRT for GPs based on NICE guidance 2015 Written by Dr Imogen Shaw This guidance is designed to support you

More information

Menopause Guidance on management and prescribing

Menopause Guidance on management and prescribing Menopause Guidance on management and prescribing DIAGNOSIS The following can be diagnosed without laboratory tests in otherwise healthy women aged over 45 years with appropriate menopausal symptoms: Peri-menopause

More information

Menopause and Hormone Replacement Therapy

Menopause and Hormone Replacement Therapy Menopause and Hormone Replacement Therapy Daniel Breitkopf, MD Department of Obstetrics and Gynecology University of Texas Medical Branch Galveston, Texas USA Objectives Define the indications and contraindications

More information

Executive Summary and Questions and Answers

Executive Summary and Questions and Answers Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phase of the Women s Health Initiative Randomized Trials (Manson et al., 2013) Table of Contents Executive

More information

menopause and menopause treatments

menopause and menopause treatments menopause and menopause treatments what is menopause? Menopause is the time in a woman s life when her period stops. It is a normal change in a woman s body. A woman has reached menopause when she has

More information

Hormone replacement therapy:

Hormone replacement therapy: www.bpac.org.nz keyword: hrt Hormone replacement therapy: latest evidence and treatment recommendations Key advisor: Dr Helen Roberts, Senior Lecturer, Department of Obstetrics and Gynaecology, Faculty

More information

New Guidelines for Menopause Management

New Guidelines for Menopause Management Controversies in Women s Health December, 2012 New Guidelines for Menopause Management Michael S. Policar, MD, MPH Clinical Professor of Ob,Gyn, & RS UCSF School of Medicine policarm@obgyn.ucsf.edu I have

More information

Hormone Replacement Therapy and the Menopause. Paul O Connell & Fiona Brown

Hormone Replacement Therapy and the Menopause. Paul O Connell & Fiona Brown Hormone Replacement Therapy and the Menopause Paul O Connell & Fiona Brown Menopause Menopause: permanent cessation of menstruation that results from loss of ovarian follicular activity. diagnosed retrospectively

More information

Menopause. Objectives: Menopause 4/29/2015

Menopause. Objectives: Menopause 4/29/2015 Menopause Nurse Practitioners of NEPA Annual Primary Care Conference May 1,2015 Barbara Plucknett, MD Objectives: 1. to define perimenopause and menopause 2. Pathophysiology of perimenopause and menopause

More information

Hormone Replacement Therapy (HRT) and the Menopause

Hormone Replacement Therapy (HRT) and the Menopause Hormone Replacement Therapy (HRT) and the Menopause What is The Menopause? All women will go through the menopause. The average age of the menopause in the UK is 51 years. As it is an average, some women

More information

Post Menopausal Hot Flashes Medical Insights Market Opportunity. Tro Kalayjian Physician Chimera Research Group

Post Menopausal Hot Flashes Medical Insights Market Opportunity. Tro Kalayjian Physician Chimera Research Group Post Menopausal Hot Flashes Medical Insights Market Opportunity Tro Kalayjian Physician Chimera Research Group Outline Introduction & Presentation Epidemiology Comorbidities Pathophysiology Women s Health

More information

Surviving and Thriving through Menopause. by Obstetrician/Gynecologist Leigh Bauer, D.O. Cuyuna Regional Medical Center

Surviving and Thriving through Menopause. by Obstetrician/Gynecologist Leigh Bauer, D.O. Cuyuna Regional Medical Center Surviving and Thriving through Menopause by Obstetrician/Gynecologist Leigh Bauer, D.O. Cuyuna Regional Medical Center As women enter their 40s and 50s there are a number of changes going on within their

More information

This information explains the advice about menopause that is set out in NICE guideline NG23.

This information explains the advice about menopause that is set out in NICE guideline NG23. Information for the public Published: 12 November 2015 nice.org.uk About this information NICE guidelines provide advice on the care and support that should be offered to people who use health and care

More information

Dr. Friedman s Guide to Estrogen Replacement

Dr. Friedman s Guide to Estrogen Replacement Dr. Friedman s Guide to Estrogen Replacement There are risks and benefits with all medicines and estrogen replacement is no exception. In fact, estrogen replacement is one of the most controversial topics

More information

Hormonal Contraception: Injections, Implants, Rings, and Patches

Hormonal Contraception: Injections, Implants, Rings, and Patches WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Hormonal Contraception: Injections, Implants, Rings, and Patches In addition to oral contraceptives (birth control pills), there are several

More information

The Women s Health Initiative where are we a decade later?

The Women s Health Initiative where are we a decade later? The Women s Health Initiative where are we a decade later? Henry G. Burger MIMR-PHI Institute & Jean Hailes for Women s Health, Melbourne, Australia Disclosures: Henry Burger Sources of Funding Pharmaceutical

More information

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) Hormone replacement therapy (HRT) The leaflet aims to answer your questions about taking HRT to treat your menopausal symptoms. If you have any questions or concerns, please speak to the doctor or nurse

More information

Low Dose Vaginal Estrogen: Remaining Questions

Low Dose Vaginal Estrogen: Remaining Questions North American Menopause Society Third Utian Translational Science Symposium October 4, 2016 Orlando, FL Low Dose Vaginal Estrogen: Remaining Questions Jan L Shifren, MD, NCMP Associate Professor of Obstetrics,

More information

Obesity and the Menopause. Vanessa M. Barnabei, MD, PhD Professor and Chair Department of Obstetrics and Gynecology

Obesity and the Menopause. Vanessa M. Barnabei, MD, PhD Professor and Chair Department of Obstetrics and Gynecology Obesity and the Menopause Vanessa M. Barnabei, MD, PhD Professor and Chair Department of Obstetrics and Gynecology Educational Objectives Review normal menopausal transition Review health risks of obesity

More information

Contraception and peri-menopause. A Beliard, Department of Obstetrics & Gynecology CHR, Liege University

Contraception and peri-menopause. A Beliard, Department of Obstetrics & Gynecology CHR, Liege University Contraception and peri-menopause A Beliard, Department of Obstetrics & Gynecology CHR, Liege University Definition of peri-menopause Menopausal transition = Interval in which a woman's body makes a natural

More information

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) What is hormone replacement therapy (HRT)? Hormone replacement therapy (HRT) is a treatment for the symptoms of the menopause. As women get older their normal cycle of production of the hormones estrogen

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Benefits and risks of hormone replacement therapy bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis Endometriosis WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 The lining of the uterus is called the endometrium. Sometimes, endometrial tissue grows elsewhere in the body. When this happens

More information

Menopause and Hormone Therapy:

Menopause and Hormone Therapy: Menopause and Hormone Therapy: Dr Zeelha Abdool Introduction: Menopause is defined as the permanent cessation of menstruation (1 year after your last period), and is therefore a retrospective diagnosis.

More information

Hormone. Replacement. Therapy. Information leaflet. This information is also available on request in other formats by phoning 01387 241053.

Hormone. Replacement. Therapy. Information leaflet. This information is also available on request in other formats by phoning 01387 241053. Hormone Replacement Therapy This information is also available on request in other formats by phoning 01387 241053. Information leaflet Produced by Dr H Currie & Sr. K Martin May 2005 Updated Dec. 2013

More information

The Menopause. Nicola Clarke 4th year, Univesity of Leeds

The Menopause. Nicola Clarke 4th year, Univesity of Leeds The Menopause Definition The menopause in it s literal definition means the end of monthly cycles ; from the Greek word paussis (cessation) and the root men- (month) 1. This definition, however, refers

More information

What s New in Management of the Menopause?

What s New in Management of the Menopause? 1 UCSF Mini Medical School, Women s Health 17 February 2015 What s New in Management of the Menopause? Michael S. Policar, MD, MPH Clinical Professor of Ob,Gyn, & RS UCSF School of Medicine policarm@obgyn.ucsf.edu

More information

Bio-Identical Hormone Replacement Therapy (BHRT)

Bio-Identical Hormone Replacement Therapy (BHRT) 102 W. Broad St., Central City, KY 42330 Phone: (270) 754-1545 311 Henton St, Livermore, KY 42352 Phone: (270) 278-5537 2200 E. Parish Ave., Owensboro, KY 42303 Phone: (270) 926-6260 Bio-Identical Hormone

More information

Sex Hormones Pharmacology. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D

Sex Hormones Pharmacology. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D Sex Hormones Pharmacology University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 Learning Objectives: Understand the regulation of sex hormone release Know

More information

NICE guideline Published: 12 November 2015 nice.org.uk/guidance/ng23

NICE guideline Published: 12 November 2015 nice.org.uk/guidance/ng23 Menopause: diagnosis and management NICE guideline Published: 12 November 2015 nice.org.uk/guidance/ng23 NICE 2015. All rights reserved. Contents Recommendations... 3 1.1 Individualised care... 3 1.2 Diagnosis

More information

Hormone therapy and breast cancer: conflicting evidence. Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group

Hormone therapy and breast cancer: conflicting evidence. Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group Hormone therapy and breast cancer: conflicting evidence Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group The world of hormone therapy in the 1990 s Throughout the 1970s, 1980s and 1990s

More information

Efficacy and Tolerability of Antidepressant Duloxetine for Treatment of Hot Flushes in Menopausal Women

Efficacy and Tolerability of Antidepressant Duloxetine for Treatment of Hot Flushes in Menopausal Women Efficacy and Tolerability of Antidepressant Duloxetine for Treatment of Hot Flushes in Menopausal Women Irina Shestakova, MD, PhD Research Center of Obstetrics, Gynecology and Perinatology Department of

More information

Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions

Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions Hormone Restoration: Is It Right for You? Patricia A. Stafford, M.D. Founder, Wellness ReSolutions IMPORTANCE OF HORMONE BALANCE Importance of Hormone Balance Help you live a long, healthy life Help you

More information

The Menopause and HRT

The Menopause and HRT Page 1 of 5 The Menopause and HRT The menopause can cause various symptoms such as hot flushes, and changes to the vagina and genital skin. Hormone replacement therapy (HRT) eases symptoms. However, if

More information

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention Robert B. Wallace, MD, MSc Departments of Epidemiology and Internal Medicine University of Iowa College of Public Health

More information

Center for Specialized Gynecology Susan Kaufman, DO * Jodi Benett, DO * Beverly Mikes, MD Mary Steen, NPC, APN. Hot flashes

Center for Specialized Gynecology Susan Kaufman, DO * Jodi Benett, DO * Beverly Mikes, MD Mary Steen, NPC, APN. Hot flashes Definition Center for Specialized Gynecology Susan Kaufman, DO * Jodi Benett, DO * Beverly Mikes, MD Mary Steen, NPC, APN Hot flashes Hot flashes can happen at any time, leaving you sweaty and red-faced.

More information

Managing the Post-Menopausal Woman. Seddah Moya, M.D.

Managing the Post-Menopausal Woman. Seddah Moya, M.D. Managing the Post-Menopausal Woman Seddah Moya, M.D. Objectives Managing menopausal symptoms Managing bone health and fracture risk Options for decreased libido and dyspareunia Menopause Average age is

More information

POSTMENOPAUSAL ESTROGEN REPLACEMENT THERAPY

POSTMENOPAUSAL ESTROGEN REPLACEMENT THERAPY POSTMENOPAUSAL ESTROGEN REPLACEMENT THERAPY Dorie W. Schwertz, PhD (2/01) University of Illinois at Chicago Hormone Replacement Therapy (HRT) and Estrogen Replacement Therapy (ERT) Menopause - loss of

More information

Post treatment concerns for cancer survivors: a focus on breast cancer.

Post treatment concerns for cancer survivors: a focus on breast cancer. Post treatment concerns for cancer survivors: a focus on breast cancer. Presentations made by Dr Belinda Kiely Medical Oncologist Concord Cancer Centre at the March Public Forum of the Sydney Survivorship

More information

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP)

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) European Medicines Agency Pre-authorisation Evaluation of Medicines for Human Use London, 13 October 2005 Doc. Ref. EMEA/CHMP/021/97 Rev. 1 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE

More information

The Menopause and Subtotal Hysterectomy

The Menopause and Subtotal Hysterectomy Oxford University Hospitals NHS Trust Women s Health The Menopause and Subtotal Hysterectomy Information for patients The menopause At the menopause the ovaries stop working. This means that the female

More information

Management of Menopause Hot Flashes Management: General A. Wear cool clothing A. Participate in regular Exercise

Management of Menopause Hot Flashes Management: General  A. Wear cool clothing A. Participate in regular Exercise Management of Menopause Hot Flashes Management: General http://www.fpnotebook.com/gyn146.htm A. Wear cool clothing A. Participate in regular Exercise program A. Avoid Exacerbating food products 1. Caffeine

More information

Smoking and Age of Menopause. Women who smoke experience menopause an average of 2 years earlier than women who do not smoke.

Smoking and Age of Menopause. Women who smoke experience menopause an average of 2 years earlier than women who do not smoke. Menopause Menopause Feared event To many, it indicates old age - a sign of life coming to a close. Many expect a difficult psychological adjustment to menopause (bad press, bad jokes). Menopause Effect

More information

Hormone Replacement Therapy For Women

Hormone Replacement Therapy For Women Hormone Replacement Therapy For Women Bio-identical Hormone Replacement Therapy Gail Eberharter M.D. May 10, 2009 There are three main hormones that are responsible for the menstrual cycle, sexual drive

More information

Now that your Doctor has prescribed Livial for you

Now that your Doctor has prescribed Livial for you Now that your Doctor has prescribed Livial for you This educational brochure is only for use by patients prescribed LIVIAL The Menopause The term menopause refers to the very last menstrual period a woman

More information

What is the menopause?

What is the menopause? Dr Robyn Leake What is the menopause? Permanent cessation of ovarian production of follicles and female hormones Clinically no periods for 12 months Can be assessed by day 2 FSH and LH Perimenopause is

More information

Sunday, May 6. Power Surge: History and Current Treatment Options for Hot Flashes 3/28/2012

Sunday, May 6. Power Surge: History and Current Treatment Options for Hot Flashes 3/28/2012 Power Surge: History and Current Treatment Options for Hot Flashes 2012 Regional Osteopathic Medical Education (ROME ) Southeast Conference Sunday, May 6 Power Surge: History and Current Treatment Options

More information

Perimenopausal Bleeding and Bleeding After Menopause

Perimenopausal Bleeding and Bleeding After Menopause WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Perimenopausal Bleeding and Bleeding After Menopause During perimenopause, your periods may become less predictable. These changes are common.

More information

Genitourinary Syndrome of Menopause (GSM) Estrogen and Beyond

Genitourinary Syndrome of Menopause (GSM) Estrogen and Beyond Genitourinary Syndrome of Menopause (GSM) Estrogen and Beyond Barbara S. Apgar, MD, MS Professor of Family Medicine University of Michigan Medical Center Ann Arbor, Michigan Disclosure: nothing in regards

More information

Care Guidelines: Contraception

Care Guidelines: Contraception Care Guidelines: Contraception Abstinence : o If ALL sexual activity avoided (including skin to skin contact) 100% effective at preventing pregnancy and STDs o No side effects o No protection if sexual

More information

NICE guideline: diagnosis and management of the menopause

NICE guideline: diagnosis and management of the menopause GUIDELINES n NICE guideline: diagnosis and management of the menopause STEVE CHAPLIN The new NICE guideline on the menopause published in November provides information on diagnosis and the risks and benefits

More information

Hormone Replacement Therapies. Aren t They All the Same?

Hormone Replacement Therapies. Aren t They All the Same? Hormone Replacement Therapies Aren t They All the Same? Contents 2 INTRODUCTION: What is Hormonal Imbalance? 3 4 CHAPTER 1: Bio identical Hormone Replacement Therapy 5 6 BHRT for Women 7 BHRT for Men 7

More information

Shira Miller, M.D. Los Angeles, CA 310-734-8864 www.shiramillermd.com. The Compounding Pharmacy of Beverly Hills Beverly Hills Public Library

Shira Miller, M.D. Los Angeles, CA 310-734-8864 www.shiramillermd.com. The Compounding Pharmacy of Beverly Hills Beverly Hills Public Library Shira Miller, M.D. Los Angeles, CA 310-734-8864 The Compounding Pharmacy of Beverly Hills Beverly Hills Public Library 2 Outline What is hormone therapy? Why would healthy men and women need to think about

More information

Guide for Using Levonorgestrel and Ethinyl Estradiol Tablets USP (0.15 mg/0.03 mg) and Ethinyl Estradiol Tablets USP (0.01 mg)

Guide for Using Levonorgestrel and Ethinyl Estradiol Tablets USP (0.15 mg/0.03 mg) and Ethinyl Estradiol Tablets USP (0.01 mg) FDA-Approved Patient Labeling Guide for Using Levonorgestrel and Ethinyl Estradiol Tablets USP (0.15 mg/0.03 mg) and Ethinyl Estradiol Tablets USP (0.01 mg) WARNING TO WOMEN WHO SMOKE Do not use levonorgestrel

More information

HRT+YOU. All you need to know. Edited by Professor William Thompson, Queen s University, Belfast

HRT+YOU. All you need to know. Edited by Professor William Thompson, Queen s University, Belfast HRT+YOU All you need to know Edited by Professor William Thompson, Queen s University, Belfast HRT+YOU All you need to know The views represented in this publication are not necessarily those of the publisher

More information

Hormone Therapy Products Available in Canada for Treatment of Menopausal Symptoms

Hormone Therapy Products Available in Canada for Treatment of Menopausal Symptoms Hormone Therapy Products Available in Canada for Treatment of Menopausal Symptoms 2 nd Edition Physician Desk Reference A clinical resource provided to you by Unsupported Hormone Therapies Custom-Compounded

More information

What are bioidentical hormones?

What are bioidentical hormones? What are bioidentical hormones? (This article was first printed in the August 2006 issue of the Harvard Women s Health Watch. For more information or to order, please go to http://www.health.harvard.edu/womens.)

More information

Choosing a Birth Control Method

Choosing a Birth Control Method Choosing a Birth Control Method What is birth control? Birth control is any method used to prevent pregnancy. Another word for birth control is contraception. If you have sex without birth control, there

More information

Abnormal Uterine Bleeding FAQ Sheet

Abnormal Uterine Bleeding FAQ Sheet Abnormal Uterine Bleeding FAQ Sheet What is abnormal uterine bleeding? Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period. Bleeding that occurs between

More information

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT PROVERA (A PROGESTIN HORMONE)?

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT PROVERA (A PROGESTIN HORMONE)? PATIENT INFORMATION PROVERA (medroxyprogesterone acetate tablets, USP) Read this PATIENT INFORMATION before you start taking PROVERA and read the patient information each time you refill your PROVERA prescription.

More information

Hormone Therapy Products Available in Canada for Treatment of Menopausal Symptoms Physician Desk Reference

Hormone Therapy Products Available in Canada for Treatment of Menopausal Symptoms Physician Desk Reference Hormone Therapy Products Available in Canada for Treatment of Menopausal Symptoms Physician Desk Reference A clinical resource provided to you by Prescribing Hormone Therapy Physicians today have a wide

More information

Hormone Therapy with Tamoxifen

Hormone Therapy with Tamoxifen What is hormone-receptor-positive breast cancer? Many breast cancers need estrogen and/or progesterone (female hormones), to grow and spread. When breast cancer is found, the cancer is tested for two proteins,

More information

Contraceptive Counseling Module content: Contraceptive Counseling Script in English

Contraceptive Counseling Module content: Contraceptive Counseling Script in English Contraceptive Counseling Module content: Contraceptive Counseling Script in English Overview The contraceptive counseling script is a tool used to make contraceptive counseling as comprehensive and efficient

More information

Menopause and Perimenopause

Menopause and Perimenopause Menopause and Perimenopause What is menopause? What is perimenopause? Menopause is the point in a woman s life when she has not had a menstrual period for 1 year. Menopause marks the end of the childbearing

More information

Combination Birth Control Pills - FAQ

Combination Birth Control Pills - FAQ Combination Birth Control Pills - FAQ How does the birth control pill work? prevents ovulation thickens cervical mucus, which makes it hard for sperm to enter the uterus thins the lining of the uterus,

More information

Disclosure. Objectives 8/6/2015. Bio-Identical Hormone Replacement Therapy (BHRT): TO B-HRT OR NOT TO B-HRT. 49th Annual Meeting

Disclosure. Objectives 8/6/2015. Bio-Identical Hormone Replacement Therapy (BHRT): TO B-HRT OR NOT TO B-HRT. 49th Annual Meeting 49th Annual Meeting Bio-Identical Hormone Replacement Therapy (BHRT): TO B-HRT OR NOT TO B-HRT Cassie Bozeman, Pharm. D. Personalized Medicine, Compounding, and Research Fellow Florida Society of Health-System

More information

Jean Golden-Tevald, D.O., CFCMC, FCP

Jean Golden-Tevald, D.O., CFCMC, FCP Jean Golden-Tevald, D.O., CFCMC, FCP MorningStar Family Health Center Clinton, NJ American Academy of FertilityCare Professionals New Orleans, LA August 8, 2013 Faculty Disclosure Jean Golden-Tevald, DO

More information

PROVERA (medroxyprogesterone acetate) Product Monograph Page 34 of 38

PROVERA (medroxyprogesterone acetate) Product Monograph Page 34 of 38 PART III: CONSUMER INFORMATION PR PROVERA* (medroxyprogesterone acetate) This leaflet is part III of a three-part "Product Monograph" published when PROVERA was approved for sale in Canada and is designed

More information

Contraception in the perimenopause

Contraception in the perimenopause Contraception in the perimenopause ICGP May 2007 Gilly Andrews RGN Contraception to HRT X Factors influencing fertility. epidemic of pregnancy in middle-age age ¹ delay starting a family as women BUT Fertility

More information

Birth Control Pills Yearly healthy living exams Looking for more health information?

Birth Control Pills Yearly healthy living exams Looking for more health information? 2011 Birth Control Pills Birth Control Pills How do birth control pills work? Birth control pills usually contain 2 sex hormones, estrogen and progestin. The birth control pill prevents the release of

More information

Hormone Therapy: The Pendulum Swings Finding the Right Balance

Hormone Therapy: The Pendulum Swings Finding the Right Balance Hormone Therapy: The Pendulum Swings Finding the Right Balance by Dr. Diana Hoppe Menopause is a time of great change and confusion! Not only can menopausal symptoms be incredibly challenging, but so can

More information

Hot Off the Press: The Latest News in Menopause

Hot Off the Press: The Latest News in Menopause Hot Off the Press: The Latest News in Menopause Zaher Merhi M.D. Assistant Professor University of Vermont College of Medicine Department of Obstetrics & Gynecology Division of Reproductive Endocrinology

More information

The Menopausal Transition (Perimenopause)

The Menopausal Transition (Perimenopause) The Menopausal Transition (Perimenopause) What is the menopausal transition? As you reach your late forties or early fifties, the hormone levels in your body change and you start the transition into menopause.

More information

Clinical Pearls in Women s Health Minnesota ACP 2013

Clinical Pearls in Women s Health Minnesota ACP 2013 Clinical Pearls in Women s Health Minnesota ACP 2013 WOMEN S HEALTH CLINIC Stephanie Faubion Director, Women s Health Clinic No Financial Disclosures Learning objectives Be able to counsel patients on

More information

BIOIDENTICAL HORMONE REPLACEMENT THERAPY

BIOIDENTICAL HORMONE REPLACEMENT THERAPY BHRT Data supports* that hormone replacement therapy with pellet implants is an effective bio-identical method to deliver hormones in both men and women. Implants, placed under the skin, consistently release

More information

Menopause: should I take HRT?

Menopause: should I take HRT? Patient information from the BMJ Group Menopause: should I take HRT? The menopause is when your periods stop for good. It isn't an illness. It's a normal part of every woman's life. But sometimes it causes

More information

PATIENT PACKAGE INSERT BRIEF SUMMARY. DESOGEN Tablets. (desogestrel and ethinyl estradiol tablets USP)

PATIENT PACKAGE INSERT BRIEF SUMMARY. DESOGEN Tablets. (desogestrel and ethinyl estradiol tablets USP) PATIENT PACKAGE INSERT BRIEF SUMMARY DESOGEN Tablets 28 Day Regimen (desogestrel and ethinyl estradiol tablets USP) This product (like all oral contraceptives) is intended to prevent pregnancy. It does

More information

Abigail R. Proffer, M.D. October 4, 2013

Abigail R. Proffer, M.D. October 4, 2013 Abigail R. Proffer, M.D. October 4, 2013 Topics Human Papillomavirus (HPV) Vaccines Pap smears Colposcopy Contraception Polycystic Ovary Syndrome (PCOS) Can I get pregnant? Miscarriage Abnormal Uterine

More information

HORMONE REPLACEMENT THERAPY: RISKS AND BENEFITS

HORMONE REPLACEMENT THERAPY: RISKS AND BENEFITS WHI - Volume 1, Section 2 - HRT For Women Who Either Do or Do Not Have a Uterus Page 1 HORMONE REPLACEMENT THERAPY: RISKS AND BENEFITS (FOR WOMEN WHO EITHER DO OR DO NOT HAVE A UTERUS) R:/DOC/MAN/CUR/VOL1/HRTE.DOC

More information

Supervised by : Pharm.D Bayan Ababneh. Done By Pharm.D Students :

Supervised by : Pharm.D Bayan Ababneh. Done By Pharm.D Students : شعبة المعلومات الدوائية / مستشفى الملك المؤسس عبد هللا الجامعي Supervised by : Pharm.D Bayan Ababneh Done By Pharm.D Students : Gaida Almaaytah Aseel AbuSara Hana Eyyad Al-Khalaileh Doa'a Mahmoud Mohammad

More information

Contraception: Common Problems and FAQS. Dr Christine Roke National Medical Advisor, Family Planning September 2014

Contraception: Common Problems and FAQS. Dr Christine Roke National Medical Advisor, Family Planning September 2014 Contraception: Common Problems and FAQS Dr Christine Roke National Medical Advisor, Family Planning September 2014 ECP failure High fertility risk e.g. few days before ovulation, missed pills 1 st week

More information

Abnormal Uterine Bleeding

Abnormal Uterine Bleeding Abnormal Uterine Bleeding Dr. Brett Vair, MD FRCSC, Obstetrics & Gynecology 90 th Annual Dalhousie Refresher Course December 2, 2016 Disclosure In the past, I have been a presenter with Bayer Mitigating

More information

Bio-Identical Hormone FAQ s

Bio-Identical Hormone FAQ s Bio-Identical Hormone FAQ s What are bio-identical hormones? They are derived from a natural plant source and professionally compounded to be biologically identical to human form of estradiol and testosterone.

More information

PREMARIN (conjugated estrogens tablets, USP) What is the most important information I should know about PREMARIN (an estrogen mixture)?

PREMARIN (conjugated estrogens tablets, USP) What is the most important information I should know about PREMARIN (an estrogen mixture)? PREMARIN (conjugated estrogens tablets, USP) Rx only PATIENT INFORMATION PREMARIN (conjugated estrogens tablets, USP) Read this PATIENT INFORMATION before you start taking PREMARIN and read what you get

More information

DEPRESSION DURING THE TRANSITION TO MENOPAUSE: A Guide for Patients and Families

DEPRESSION DURING THE TRANSITION TO MENOPAUSE: A Guide for Patients and Families DEPRESSION DURING THE TRANSITION TO MENOPAUSE: A Guide for Patients and Families David A. Kahn, MD, Margaret L. Moline, PhD, Ruth W. Ross, MA, Lori L. Altshuler, MD, and Lee S. Cohen, MD www.womensmentalhealth.org

More information

Perimenopause and Menopause Changing with Grace! Heather Shannon, MS, CNM, NP, MPH Upstate Midwifery Program

Perimenopause and Menopause Changing with Grace! Heather Shannon, MS, CNM, NP, MPH Upstate Midwifery Program Perimenopause and Menopause Changing with Grace! Heather Shannon, MS, CNM, NP, MPH Upstate Midwifery Program Disclosure I do not have any financial relationships with any commercial organizations. Midlife

More information

Managing your Symptoms of Menopause after Cancer Treatment

Managing your Symptoms of Menopause after Cancer Treatment Managing your Symptoms of Menopause after Cancer Treatment Information for women who have finished treatment UHN Read this handout to learn about: What are the symptoms of menopause? Will my periods come

More information

Subcutaneous Testosterone-Anastrozole Therapy in Breast Cancer Survivors. 2010 ASCO Breast Cancer Symposium Abstract 221 Rebecca L. Glaser M.D.

Subcutaneous Testosterone-Anastrozole Therapy in Breast Cancer Survivors. 2010 ASCO Breast Cancer Symposium Abstract 221 Rebecca L. Glaser M.D. Subcutaneous Testosterone-Anastrozole Therapy in Breast Cancer Survivors 2010 ASCO Breast Cancer Symposium Abstract 221 Rebecca L. Glaser M.D., FACS Learning Objectives After reading and reviewing this

More information

Presenting Genital Symptoms and Physical Signs of Vaginal Atrophy

Presenting Genital Symptoms and Physical Signs of Vaginal Atrophy Sexual Health in the Menopause Presenting Genital Symptoms and Physical Signs of Vaginal Atrophy Symptoms Dryness Itching Burning Dyspareunia Signs on Physical Exam Pale, smooth, or shiny vaginal epithelium

More information

Menopause & Hormone Therapy

Menopause & Hormone Therapy Menopause & Hormone Therapy The Verdict! In 2012 there were two important medical articles that brought clarity to a decade of fear and confusion regarding the risks and benefits of hormone therapy in

More information

Contraception and HRT for women with migraine: choices and challenges. Combined Hormonal Contraception. Questions. Course of migraine with CHCs

Contraception and HRT for women with migraine: choices and challenges. Combined Hormonal Contraception. Questions. Course of migraine with CHCs Contraception and HRT for women with migraine: choices and challenges Combined Hormonal Contraception Dr Anne MacGregor www.migraineclinic.org.uk anne.macgregor747@migraineclinic.org.uk Combined Hormonal

More information

Managing Menopausal Symptoms Kirsten J. Lund, M.D. Associate Professor, OB-GYN University of Colorado

Managing Menopausal Symptoms Kirsten J. Lund, M.D. Associate Professor, OB-GYN University of Colorado Managing Menopausal Symptoms Kirsten J. Lund, M.D. Associate Professor, OB-GYN University of Colorado Disclosures No ties, financial or otherwise, to pharmaceutical companies Will identify non-fda approved

More information